Beruflich Dokumente
Kultur Dokumente
The left column is the information as given during the lecture. The column at the right gives you space to make
personal notes.
Learning outcomes
At the end of this lecture you will be able to:
• Discuss the importance of blood supply for hip fractures
• Explain the importance of positioning, reduction, and perioperative sterility
• Describe the implant choice and the procedure step-by-step
• Suggest how complications can be avoided
Aim of treatment
The aim of the treatment is
• Stable fixation that always
allows immediate weight
bearing
• Minimize potential for
implant failure
• Maximize potential for
return to prefracture
mobility
Hip fractures
Hip fractures are
1. High-energy fractures
These less common fractures
are often caused by road
accidents. The patients are
often young with multiple
traumata.
2. Low-energy fractures
15% of women and 5% of men will
sustain this type of fracture which
is mainly due to osteoporosis. The
treatment of these fractures costs
the health sector billions each year
and they have a mortality of 10%
at one month and 30% at one
year.
Blood supply
Technique
Step 1─reduction
In many cases the traction table is used. The reduction is
done on this table and before the patient is draped.
Important also is to guarantee smooth access of the image
intensifier in both planes; AP and lateral.
Technique
Step 1─reduction
The same procedure as for DHS is followed.
Advantages
PFNA more stable:
• For reverse oblique fractures
• For subtrochanteric fractures
Complications
PFNA less stable
o In periprosthetic fractures (in some countries; eg,
UK, the short PFNA is no longer recommended)
Periprosthetic fracture
o More common in:
• Short IM nails than in
DHS
• Nails where distal screw is
near tip of the nail
Infection
o Sterility is important
Case
This intertrochanteric fracture with
subtrochanteric
extension was treated
with a DHS.
3. C-arm:
Protect drape when turning from
AP to lateral view
Support surgeon
1. Support surgeon to follow the
correct procedure.
2. Control completeness of
instrument sets.
Summary
You should now be able to
• Discuss the importance of blood supply for hip
fractures
• Explain the importance of positioning, reduction, and
perioperative sterility
• Describe the implant choice and the procedure step-
by-step
• Suggest how complications can be avoided